Trump-Harris debate: Takeaways on ACA, private health insurance

The Affordable Care Act — the federal health insurance law also known as Obamacare — was one of the few employee benefits issues that got much attention during the presidential debate Tuesday.

Vice President Kamala Harris, the Democratic nominee, talked about her support for the law and for keeping a place in the system for the sale of private health insurance.

What Trump said

Former President Donald Trump discussed his hopes for replacing the law and explained why the ACA public health insurance programs and other health insurance exchange programs continued to function reasonably well while he was in the White House, in spite of his efforts to work through Congress and the courts to repeal the ACA.

“Obamacare was lousy health care,” Trump said. “Always was. It’s not very good today.”

Trump said that, if his administration had “come up with something,” he would have replaced it.

“But, remember this: I inherited Obamacare because Democrats wouldn’t change it,” Trump said. “They were unanimous. They wouldn’t vote to change it. If they would have done that, we would have had a much better plan than Obamacare.”

Because of Democratic opposition to changing the ACA, he said, “I had a choice to make when I was president: Do I save it and make it as good as it can be? Never going to be great. Or do I let it rot?”

Trump said he felt an obligation to keep it going, “even though politically it would have been good to just let it rot and let it go away.”

“And I saved it,” Trump said. “I did the right thing. But it’s still never going to be great. And it’s too expensive for people. And what we will do is, we’re looking at different plans. If we can come up with a plan that’s going to cost our people, our population less money and be better health care than Obamacare, then I would absolutely do it. But until, then I’d run it as good as it can be run.”

When asked whether he has a plan for replacing the ACA framework now, he said, “I have concepts of a plan.”

Harris’s views

Harris was asked about her past support for health system reform efforts proposed by Sen. Bernie Sanders, an independent from Vermont who caucuses with the Democrats. Sanders has proposed “Medicare for all” bills that would eliminate all forms of private health insurance, and the current Medicare program.

“I absolutely support and over the last four years as vice president private health care options,” Harris said. “But what we need to do is maintain and grow the Affordable Care Act.”

Harris said Trump’s history on the ACA shows he would continue to try to overturn it without having a plan for replacing it.

“When Donald Trump was president, 60 times he tried to get rid of the Affordable Care Act; 60 times,” Harris said. “I was a senator at the time. I will never forget the early morning hours when it was up for a vote in the United States Senate, and the late great John McCain… walked onto the Senate floor and said, ‘No, you don’t. No, you don’t. No, you don’t get rid of the Affordable Care Act.’”

The ACA has eliminated the ability of insurance companies to deny coverage to people with pre-existing conditions, Harris said.

“Remember when an insurance company could deny if a child had asthma, if someone was a breast cancer survivor, if a grandparent had diabetes?” Harris asked.

In connection with health policy, “the value I bring to this is that access to health care should be a right and not just a privilege of those who can afford it,” Harris said. “The plan has to be to strengthen the Affordable Care Act, not get rid of it.”

The context

The ACA came up near the end of the debate, which was dominated by exchanges about immigration, reproductive rights and foreign policy.

Harris squeezed in mentions of her support for a $6,000 tax credit for families with children and a $50,000 tax credit for people starting businesses.

No one used the term “retirement” or “account.”

Trump is a participant in two defined benefit pension plans because of his work and television, and Harris is a participant in multiple defined benefit pension plans because of her work in government in California, but no one involved in the debate used the word “pension.”

Harris mentioned Social Security and Medicare while responding to a question about why some of her views seem to have shifted toward the center, from the left, since she became the Democratic nominee.

“My work that is about protecting Social Security and Medicare is based on long-standing work that I have done,” Harris said. “Protecting seniors from scams. My values have not changed.”

Later, when Harris was asked about her health care plan, she talked about the Medicare prescription drug coverage changes included in the Inflation Reduction Act and how that has been something that was accomplished while she was vice president.

“We have allowed for the first time Medicare to negotiate drug prices on behalf of you, the American people,” Harris said. “Donald Trump said he was going to allow Medicare to negotiate drug prices. He never did. We did. And now we have capped the cost of insulin at $35 a month. Since I’ve been vice president, we have capped the cost of prescription medication for seniors at $2,000 a year.”

Neither Trump nor the moderators talked about concerns that the changes in the drug rules may cause shortages of some drugs and cause turmoil in the Medicare Advantage plan and Medicare Part D prescription drug plan markets during the upcoming annual enrollment period for 2025 coverage.